A Numbers Game

Screening for colorectal cancer

Demographer Samir Soneji, PhD, a member of the Cancer Center's Cancer Control Research Program and assistant professor at The Dartmouth Institute for Health Policy and Clinical Practice, provides data to help make those policy decisions.

Samir Soneji, PhD

For example, last year Dr. Soneji published research showing that African-Americans have consistently worse stage-specific colorectal cancer rates than Caucasians, and that the gap between survival rates for African-Americans and Caucasians is widening over time.

"The question policymakers have to ask themselves is, 'Who would benefit the most screening?' It's easy to say, 'Everyone,' but in an era of limited resources that’s not a useful answer," he comments.

Since 2001, Medicare has covered the cost of colonoscopies for patients aged 65 and older, and Soneji's data show that these "young elderly" benefit tremendously from colorectal cancer screening relative to cost. "What we find in our new work is that 55-59 and 60-64-year-olds may benefit the most from colorectal cancer screening because, as a population subgroup, they are old enough to have developed polyps, some of which could become cancer in later life," he says. "The question we struggle with is how to effectively screen those most at risk, even in these age groups."

But selling the benefits of public health campaigns is always a challenge, he adds, "and some of the benefits aren't obvious. An important side benefit to colorectal cancer screening is greater participation of adults in health care. People may become more comfortable with the idea of timely and appropriate colorectal cancer screening and share their experience with their family and friends."

The ultimate goal, he says, "is developing high qualify, safe, and cost-effective screening programs that benefit the most number of people and harm the least."